Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) in clinical practice

Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited myocardial disease characterized by fibro-fatty replacement of the right ventricular myocardium, and associated with paroxysmal ventricular arrhythmias and sudden cardiac death (SCD). It is currently the second most common cause of SCD after hypertrophic cardiomyopathy in young people <35 years of age, causing up to 20% of deaths in this patient population. This condition has a male preponderance and is more commonly found in individuals of Italian and Greek descent. To date, there is no single diagnostic test for ARVC/D and the diagnosis is made based on clinical, electrocardiographic, and radiological findings according to the Revised 2010 Task Force Criteria. In this review, we will discuss the mainstay treatment which includes pharmacotherapy, implantable cardioverter-defibrillator insertion for abortion of sudden cardiac death, and in the advanced stages of the disease cardiac transplantation

Autisme, psychose précoce, troubles envahissants du développement

International audienceDans la nouvelle version de la classification française des troubles mentaux de l'enfant et de l'adolescent (CFTMEA-R2010), la notion de psychose précoce a été conservée dans le cadre de la catégorie "Troubles envahissants du développement (TED)", définis par les classifications internationales (DSM-IV et CIM-10). Au sein des TED, les catégories diagnostiques "Psychose précoce déficitaire" ("retard mental avec troubles autistiques ou psychotiques") et "Dysharmonie Multiple et Complexe du Développement (MCDD) -Dysharmonie psychotique", restent individualisées. Un effort particulier a été fait pour faciliter les correspondances entre ces catégories diagnostiques de la CFTMEA-R2010 et de la CIM-10, en vue du relevé informatisé d'activité (RIM-Psy) et des travaux de recherche internationaux

Cardiac resynchronization therapy in the ageing population - With or without an implantable defibrillator?

Cardiolog

Transvenous revision of leads with cardiac perforation following device implantation-Safety, outcome, and complications

Introduction Cardiac perforation is a rare complication of cardiac implantable electronic device (CIED) implantation. Transvenous revision of perforated leads is associated with the risk of cardiac tamponade and death. Little is known about periprocedural complications and outcome of these patients.Methods and results All patients referred to our department with evidence or suspicion of cardiac perforation following CIED implantation underwent chest X-ray, transthoracic echocardiography, device interrogation, and, if necessary, a cardiac computed tomography (CT)-scan to diagnose lead perforation and associated complications. Transvenous lead revision (TLR) was performed in all patients with evidence of lead perforation. Patient characteristics, procedural complications, and outcome were recorded and analyzed.Fifty-six patients (75 +/- 10 years, 43% male) were diagnosed with cardiac perforation, 34 patients (61%) early within 30 days post-implantation, and 22 patients (39%) thereafter. The most frequent perforation site was the right ventricular (RV) apex (75%), followed by the RV free wall (16%) and the right atrial appendage (9%). A total of 16 patients (29%) presented with severe complications; 12 patients (21%) with pericardial effusion treated by pericardiocentesis before lead revision and four patients (7%) with hematothorax requiring drainage. Late perforations showed significantly more frequent cardiac tamponades (P = .041). TLR was performed without further complications in 54 patients (96%). None of the patients required surgical treatment or experienced in-hospital death.Conclusions Cardiac perforation following CIED implantation is associated with severe complications in nearly one-third of the cases. Transvenous revision of the perforated lead can safely be performed with a very low complication rate.Cardiolog